Navigation Links
Obese patients face increased risks for infection and dislocation following revision hip surgery
Date:5/8/2008

Along with age and injuries, obesity is a leading risk factor for osteoarthritis (OA), a painful and disabling joint disease. While excessive weight can aggravate the toll on almost any joint, obesity has been associated with a higher prevalence of hip OA and an increase in total hip arthroplasty (THA). Whether obese hip OA patients are more prone to postsurgical complications, however, remains open to debate and investigation, since the results of existing studies conflict. Whats more, only a few short-term studies have focused on how obesity affects the outcomes of revision THA. Compared to primary THA revision surgery is a longer and more complicated procedure implying more extensive tissue damage and a greater risk of prosthetic joint infections and dislocations, as well as other long-term complications.

Researchers at Geneva University Hospitals set out to evaluate the impact of obesity on the incidence of serious complications after revision THA, over a period of up to 5 years. The team also aimed to determine whether functional improvement, pain, and satisfaction 5 years after the second hip replacement differed between obese patients and patients of healthy weight. Their results, presented in the May 2008 issue of Arthritis Care & Research (www.interscience.wiley.com/journal/arthritis), reveal a strong correlation between obesity and high rates of adverse events, as well as lower functional gains and more persistent pain, after revision THA.

This long-term study focused on all patients who underwent a revision THA, excluding re-revisions, at the universitys hospitalthe only public hospital serving the urban and suburban populations of Geneva, Switzerlandbetween 1966 and 2006. Of the 204 subjects, 114 were women and 90 were men, with a mean age of 71.6 years. Based on height and weight data obtained just before surgery, 52 patients, 25 percent of the sample, were defined as obese, with a body mass index (BMI) of 30 or more. The standard range for a normal BMI, the ideal weight to height ratio, is between 18 and 25. To further assess the association between BMI and postoperative outcomes, patients were also examined in 4 BMI categories: less than 25; 25 to 29.9, defined as overweight; 30 to 34.9; and 35 or more.

Based on patient records and follow-up examinations, the researchers first documented the occurrence of one or more adverse events within 5 years after the first revision THA: surgical site infection, dislocation of the prosthetic hip, or re-revision surgery for any cause. They then relied on trusted, hip-specific clinical evaluations, including the Harris Hip Score (HHS), along with in-person and phone interviews with patients, to measure each subjects functional status, level of pain, and general satisfaction with the procedure 5 years later. Finally, researchers used statistical analyses, including incidence rates and hazard ratios, to compare the outcomes between obese and non-obese patients after revision THA.

Overall, 20 complications occurred in 17 (33 percent) of the 52 obese patients, compared with 18 events in 13 (9 percent) of the 152 non-obese patients. In terms of specific complications, the incident rate was 4 times higher for surgical site infection and 3.5 times higher for dislocation. Even more striking, the incidence rate for occurrence of one or more adverse events rose with rising BMI. This increase was small between normal and overweight patients1.5 times higher. Yet, it became significantly greater in the group with a BMI between 30 and 34.94.5 times higher than normal weight patients. And it escalated to an alarmingly increase in the group with a BMI of 35 or more10.9 times higher. In these calculations, adjustments were performed for age, sex, and preoperative health status.

For those patients scheduled for a 5 year follow-up visit, 83 percent of the obese patients and 85 percent of the non-obese patients were available for evaluation. In general, the obese patients had moderately lower functional improvements and higher levels of routine hip pain. However, patient satisfaction with the result of their revision THA was gauged to be about the same in both groups.

As its lead author, Dr. Anne Lbbeke, acknowledges, this study is limited by the relatively small number of adverse events resulting in large confidence intervals and restricting the adjustment for baseline differences between obese and non-obese patients to the most important confounding factors. Despite such weaknesses, the findings reinforce revision THA as a technically-challenging intervention, particularly when performed on obese patients.

Surgeons, patients, and referring physicians should be aware of an increased risk in this patient group, Dr. Lbbeke stresses. Further studies are necessary to evaluate whether changes in medical preparation, surgical technique, and implant choice can help reduce the adverse event rate in obese patients undergoing revision THA.


'/>"/>

Contact: Sean Wagner
swagner@wiley.com
781-388-8550
Wiley-Blackwell
Source:Eurekalert

Related medicine news :

1. How to manage Chinese obese children with non-alcoholic fatty liver disease?
2. Aspirin-like compounds increase insulin secretion in otherwise healthy obese people
3. Obese women disadvantaged in both breast cancer treatment and diagnosis
4. Obese Women Less Likely to Be Tested for Some Cancers
5. Overweight, Obese Women Improve Quality of Life With 10 to 30 Minutes of Exercise
6. Breast cancer more aggressive among obese women
7. Obese Children Face More Complications During Surgery
8. Overweight and obese men have lower PSA values, even before they get prostate cancer
9. Born to Be Obese?
10. Bone mineral content continues to increase in obese adolescents during weight loss
11. Anti-Inflammatory Drug Improves Glycemia, Lowers Inflammation in Obese, Young Adults
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:10/12/2017)... ... October 12, 2017 , ... First Healthcare Compliance (FHC), an ... showcase a range of technology and learning solutions at the 68th Annual American ... to be held October 14–18, 2017 at the Mandalay Bay Resort in Las ...
(Date:10/12/2017)... ... October 12, 2017 , ... IsoComforter, Inc. ( ... today the introduction of an innovative new design of the shoulder pad. The ... get maximum comfort while controlling your pain while using cold therapy. By utilizing ice ...
(Date:10/12/2017)... ... October 12, 2017 , ... Dr. ... recently contributed a medical article to the newly revamped Cosmetic Town journal ... spotlights the hair transplant procedure known as Follicular Unit Extraction (FUE). ...
(Date:10/12/2017)... , ... October 12, 2017 , ... ... named one of Michigan’s 2017 Best and Brightest in Wellness® by Best and ... Wellness® awards program on Friday, Oct. 20 from 7:30 a.m. to 2 p.m. ...
(Date:10/12/2017)... ... 2017 , ... Farm Forward joins Bon Appétit ... institutions in announcing the launch of the Leadership Circle , a program ... raised for food. , Founding members of the Leadership Circle also include Airbnb’s ...
Breaking Medicine News(10 mins):
(Date:9/28/2017)... 28, 2017 Hill-Rom Holdings, Inc. (NYSE: HRC), ... call and webcast on Friday, November 3, 2017, beginning ... ending at approximately 8:30 a.m. (CDT) / 9:30 a.m. ... 2017 financial performance and guidance for 2018, Hill-Rom executives ... enhance operational performance, and long-range financial outlook through 2020. ...
(Date:9/25/2017)... 25, 2017   Montrium , an industry ... today—from the IQPC Trial Master Files & Inspection ... that EastHORN Clinical Services has selected eTMF ... TMF management. EastHORN, a leading European contract research ... increase transparency to enable greater collaboration with sponsors, ...
(Date:9/22/2017)... 22, 2017 AVACEN Medical (AVACEN) announced that ... successfully helping those with the widespread pain associated with ... Amanda in Essex, England commented, ... hair, experiencing no sleep at all, tremendous pain, with ... cannot recommend [the AVACEN 100] enough, how this has ...
Breaking Medicine Technology: